akou

In an interesting turn of events, it would appear that Akou is not actually forty years old, despite what her records in our database indicate.

I sat with her this morning and chatted while she did her arm exercises. She wanted company, so together we touched our fingers to our thumbs and flexed our wrists up and down and up and down, and all the while we passed the time talking about our families.

She has four children. Her oldest is a girl, and when I asked that girl's age, Akou hesitated a moment before answering. When Anani, the translator, relayed her words back to me, I understood why. Her oldest child is thirty-five. I pressed her a little further and found out that she was twenty-four when that child was born.

I burst out laughing as I did the math. I’m not sure if she ever learned how to add, but when I spelled it out the sum to her, her smile was more than a little guilty.

She paused for a long moment, visibly debating with herself whether she could tell me the truth, but in the end decided that I could be trusted. Through Anani, her plan came out.

I didn't know if you did surgery for old people. Maybe I would be too old and you would say no to me. I thought forty would be a good age for surgery.

I don't know what it's like to live in a system where medical care is so difficult to access that the choice to lie becomes an easy one. I don't know what it's like to live for three years with a tumor growing across my back and no real chance of it being removed. I don't know how it feels to pin all my hopes on a ship full of foreigners who are only in port for a few months every few years.

All I know how to do is smile back in the face of all this, to make jokes and hug a fifty-nine year-old lady who reaches back with her one good arm to fling it around my neck and whisper sweet words into my ear.

I wish you were my baby, too. Then you could stay with me forever and make me laugh all the time.

We found Akou at one of the very first screening days, back in February of this year. She's a sweet, forty year-old woman who had a large tumor growing on the right side of her neck, extending down her back over her shoulder. Her pure joy in this photo as she holds up the card that will allow her through the gate to be admitted for surgery has become the symbol to so many of us of what we are doing here in Togo.

On Thursday, in a marathon nine-hour operation, Dr. Mark removed the tumor. It had grown insidiously over the last three years, wrapping its way around nerves and blood vessels, until it had pushed almost into the space surrounding her lungs.

When Akou returned to the wards, she was scarred from battle. Long lines of staples wound their way across her shoulder and down her back. Tubing from drains stuck out from underneath her skin. Worst of all, her right arm hung limp. You see, in order to remove the tumor, the surgeon had to cut the nerves that ran through it; there was no other way. And even though he performed the minutely complex task of stitching those nerves back together once the offending growth had been removed, the healing will only take place at the rate of about one millimeter every day. There are many millimeters to grow.

Yesterday, we stood around her bed during rounds while Dr. Gary asked her if she was happy with the surgery. She shook her head, gingerly, and explained to the translator who relayed her message to the waiting circle. She says she is not ready to see the absence of the tumor. With her arm like this, she is not ready. And it was true. Akou wasn't the smiling, happy woman from that screening day photo. She was quiet and withdrawn, her brow furrowed more often than not as she used her strong left arm to lift the right and let it fall limp again onto the pillows.

Today, I spoke out in faith at rounds. She is feeling better, and she is dancing again. When Akou heard what I had said, she shook an accusatory finger at me, calling me a liar, even though her eyes held a hint of their former shine. I told her that I was a prophet, that by the end of the day I would see her dance, and her grin was wide as she shook her head at my foolishness.

This hospital is a funny place. It's got none of the conveniences of modern facilities in the first world. No windows opening onto spacious lawns; on deck three, there are no windows at all. No privacy; each bed is two feet from the next and ten patients share one tiny bathroom. And yet every day we see patients healing in ways that would seem incredible to doctors in nurses in those first-world hospitals.

Today was that day for Akou.

I don't know what it was that changed. Maybe it was watching the VVF ladies, seven of them, as they danced into their new lives. Maybe it was the joy on little Joseph's face as he played volleyball with his nurse, a string hanging from the ceiling and a blue balloon sufficing for a net and ball. Maybe it was the constant singing and guitar playing by the translators. Whatever it was, Akou decided that she was ready.

I brought a mirror to her bed, tucked another in my pocket, and watched while she examined the scar forming under the staples on her neck. When she twisted to try and see her back, I used the second mirror to give her a better view. She spent a long while just looking at herself, examining the wounds, flexing the fingers on her weak hand.

And when she was done, she looked at me with her old grin and used her good hand to signal to me that it was good.

Later, at change of shift, we gathered with the translators and started to sing. Over and over we repeated the words until Cael, our resident guitar-player, stepped close to Akou's bed and told her she was going to be singing a solo. She nodded her agreement, and our clapping turned to quiet snaps as she raised her voice, still hoarse from the breathing tube that was down her throat during surgery, to sing.

Akpe madana Mawu.
Akpe madana Mawu.
Akpe madana Mawu, madana Mawu, madana Jesu.
Akpe madana Mawu, madana Mawu,
madana Jehovah

Her good hand was raised high in the air, the fingers on the other curling and uncurling to the rhythm of our song as we echoed her simple words together.

Thanks be to God.
Thanks be to God.
Thanks be to God, to God, to Jesus.
Thanks be to God, to God,
to Jehovah.